Talk therapy by phone may ease fibromyalgia: study

NEW YORK (Reuters Health) - Talk therapy done over the phone helped some people suffering chronic fibromyalgia-related pain to feel better in a study that looked at phone therapy as a potential cost-effective alternative to standard treatments.

Researchers found that about one-third of people who had cognitive behavioral therapy, or CBT phone sessions felt "much better" or "very much better" after a few months, compared to less than one in ten who continued their usual treatment.

"There's no doubt that cognitive behavioral therapy can be very helpful in people managing chronic pain," said Kevin Fontaine, a fibromyalgia researcher from the Johns Hopkins University School of Medicine in Baltimore, Maryland.

However, "One of the difficulties with any sort of intervention with people that have fibromyalgia is sticking to it. This idea of delivering it via a phone call... has a lot of appeal to it," Fontaine, who wasn't involved in the new study, told Reuters Health.

CBT helps patients understand how their thoughts and attitudes affect how they feel and how they respond to situations -- then addresses practical steps they can take to improve negative thoughts and outcomes.

While the technique has shown success in patients with fibromyalgia, as well as other types of chronic pain, depression and anxiety disorders, CBT isn't available everywhere and can be expensive -- starting at around $100 for an hour-long session.

"One of the major, major problems with CBT is access to the therapists themselves," said John McBeth from the University of Manchester in the UK, who worked on the study.

Doing CBT over the phone would solve the problem of availability and sessions could be shorter and cheaper, researchers proposed.

The current study involved 442 people in the UK with chronic widespread pain. Patients either had 10 telephone CBT sessions with a therapist, or were given free sessions with a fitness instructor and recommended to exercise regularly, or they did both CBT and the exercise program. A comparison group had no changes in their usual fibromyalgia treatment.

Before and after six months of those programs, all the participants answered questions about their general health, quality of life and pain.

By the end of the CBT and exercise sessions, about 33 percent of people who'd had one or both of the treatments said they were feeling at least "much better" than before the study started. That compared to only eight percent in the treatment-as-usual group.

For the most part, those benefits held up for another three months after treatments ended. Only a quarter of people in the exercise-only group felt better at the nine-month, mark, though, and many are likely to have stopped exercising by that point, the researchers note.

Despite the overall improvements in well-being some reported, participants didn't get any added benefit from CBT or exercise for specific pain symptoms, McBeth and his colleagues write in the Archives of Internal Medicine. Most of the treatments' benefits related to fatigue and how subjects coped with their pain.

McBeth added that while a cost analysis found that talk therapy was "marginally more expensive than we would have hoped for" given its benefits, his team is planning to look into strategies to cut its costs.

A few drugs are approved to treat fibromyalgia, including Cymbalta, Savella and Lyrica -- but a combination of talk therapy and exercise remains the treatment of choice, McBeth said.

Fibromyalgia "is primarily a pain condition, but it also has a lot of disorders that co-occur with it. There's a lot of fatigue and gastrointestinal symptoms," he told Reuters Health. "There isn't one magic bullet that will target all those symptoms."

Fontaine said as far as he knows, telephone CBT is not currently available to most fibromyalgia patients outside of research studies. But that could change, he added.

"If it's demonstrated to work and demonstrated to be cost-effective, it would probably be something that would begin to be used quite regularly in the clinical setting," Fontaine said.

"This study certainly suggests that it could have a clinical value and it that it could be used more routinely with these types of patients."